Maternal mortality remains a test of whether health systems reach women
Published on 29 October 2026 at 02:18 GMT
By Editorial Team SDG3
Pregnancy and childbirth remain dangerous where treatment cannot be reached in time. The World Health Organization (WHO) estimates that approximately 260,000 women died from maternal causes in 2023, most from preventable causes. WHO identifies staffing, medical supplies and household income among the factors affecting access to care.
The internationally comparable interagency estimates published in April 2025 put the global maternal mortality ratio at 197 deaths per 100,000 live births in 2023. This ratio measures maternal deaths relative to live births, rather than the total number of women dying. It provides a common denominator for comparison, while national averages can conceal differences in access within the same country.
Where attendance falls short
The United Nations Children’s Fund (UNICEF) reports that skilled personnel attended 86 per cent of births globally in 2023. Its rural and urban estimates were approximately 77 per cent and 93 per cent respectively. Coverage was 69 per cent among the poorest fifth of women within their countries, compared with 96 per cent among the wealthiest fifth.
These are differences in attendance, not direct measurements of care quality or each woman’s chance of survival. They show disparities by residence and household wealth. National coverage figures alone do not describe access for every group.
Skilled attendants can recognise complications and arrange referral. Their presence does not establish that blood, equipment or emergency treatment is available. UNICEF explicitly cautions that the attendance indicator does not fully capture access to good-quality care when complications develop. Counting attended births therefore answers a different question from whether treatment arrived in time.
An emergency tests the whole service
The United Nations Population Fund (UNFPA) distinguishes basic emergency obstetric care from comprehensive services. Basic functions include antibiotics, medicines to control bleeding and convulsions, removal of a retained placenta and assisted vaginal delivery. Comprehensive care adds capabilities including caesarean surgery and safe blood transfusion. The distinction concerns what a facility can actually do, rather than its name.
In its guidance, UNFPA describes emergency provision as a continuous service involving multiple skilled attendants and support staff. Surgery also depends on a functioning theatre, anaesthesia and transfusion capacity. A referral from a birth attendant is therefore the start of another clinical process, whose success depends on the receiving service being able to act.
These service requirements extend beyond the individual clinician. Referral connects the person identifying a complication with the team able to treat it. The availability of a facility or a birth attendant alone does not establish whether that connection functions during an emergency.
Poverty and the journey to care
The three delays framework presented by UNFPA separates delays in seeking care, reaching appropriate care and receiving treatment after arrival. Affordability, distance and transport affect the first two stages; staff, equipment and organisation affect the third. These categories show why a delay outside a hospital can have consequences that appear later inside it.
For rural households, distance interacts with the availability and cost of transport. A service within a district may still be difficult to reach during an emergency. The framework considers both the journey and treatment after arrival.
WHO identifies poor women in remote areas as least likely to receive adequate care. It also lists gender inequality, mistreatment, shortages of supplies and insufficient or inadequately trained staff among barriers. These conditions can affect both seeking assistance and obtaining it.
Care before and after delivery
Antenatal visits can identify problems such as anaemia, hypertension and infection. However, UNFPA notes that many obstetric complications arise with little warning, including among women without recognised risk factors. Screening and birth planning therefore do not remove the possibility of an emergency in an apparently uncomplicated pregnancy.
The period after birth also remains part of the same care pathway. Bleeding, infection and hypertensive disorders can develop after a woman leaves a facility. UNFPA supports postnatal follow-up alongside midwifery training, emergency care networks and maternal death reviews. These activities address different points in the pathway; none alone measures whether the entire pathway reached a particular woman.
What mortality reveals
The 2025 interagency report relates maternal mortality to SDG 3 (Good health and well-being), which includes target 3.1: reducing the global maternal mortality ratio to below 70 deaths per 100,000 live births by 2030. The estimates provide internationally comparable measures, rather than an explanation of what happened in each individual case.
UNFPA describes maternal death review and response systems as a means of understanding how many women die, why they die and how to respond. Such investigations complement coverage indicators by examining the circumstances of deaths, including possible problems in access and care.
Maternal mortality and skilled attendance measure different aspects of maternal health. Mortality estimates describe deaths relative to live births; attendance data describe contact with skilled personnel. The documented differences by residence and household wealth show why national attendance averages alone cannot establish equal access to care.
Written by a human author, edited with AI assistance.
Further information:
• WHO, Maternal mortality. The fact sheet supports the estimated death toll, preventability and barriers affecting poor and remote populations.
• WHO, Trends in maternal mortality 2000 to 2023. The interagency report supports the comparable estimates, global ratio and development target.
• UNICEF, Delivery care. The data page documents attendance disparities and limitations of the skilled attendance indicator.
• UNFPA, Setting standards for emergency obstetric and newborn care. The guidance explains basic and comprehensive services and the three delays framework.
• UNFPA, Maternal health. The overview supports antenatal and postnatal context and the agency’s work on care networks and death reviews.
